Special Article
Laparoscopic Vessel Sealing Technologies

https://doi.org/10.1016/j.jmig.2013.02.012Get rights and content

Abstract

Laparoscopic vessel sealing devices have revolutionized modern laparoscopy. These devices fall into 2 major categories: advanced bipolar and ultrasonic instruments. The range of tissue effects available with these technologies is more limited than with conventional monopolar electrosurgery; however, both advanced bipolar and ultrasonic devices efficiently seal vessels (≤7-mm and ≤5-mm diameter, respectively), and most also have built-in tissue transection capabilities. These technologies have been the subject of a range of comparative studies on their relative advantages and disadvantages, and, to date, neither advanced bipolar or ultrasonic devices has been proven to be superior.

Section snippets

Advanced Bipolar Devices

In reality, all electrosurgery is “bipolar” inasmuch as there needs to be 1 electrode from which the electrical current enters tissues and another electrode through which the current leaves the patient and returns to the electrosurgical unit (ESU) 1, 3. By convention, monopolar electrosurgery refers to the arrangement of a single small electrode contained within the surgical instrument that delivers focused alternating electrical current to the target tissue to impart the desired surgical

Ultrasonic Devices

Not dissimilar in appearance to new-generation bipolar electrosurgical devices, ultrasonic laparoscopic energy sources are also able to seal vessels and transect tissues. Indeed, most of the tissue effects produced by ultrasonic devices are the same as those for bipolar devices (Table 2). However, these tissue effects are produced without the passage of electrical current through the patient or target tissue. Ultrasonic devices instead convert electrical energy to both mechanical and thermal

Comparison of Advanced Bipolar and Ultrasonic Vessel Sealing Technologies

The reasons for a surgeon’s preference for a particular laparoscopic energy source may be many and varied. A common reason for choosing a particular instrument is the surgeon’s own experience with that instrument that may have been preordained by a mentor during surgical training. Unfamiliar technologies often are not trialed. Surgeons are also subjected to marketing strategies and even inducements. Indeed, device manufacturers sponsor many of the studies on energy sources published in the

Conclusions

The development of laparoscopic vessel sealing devices has revolutionized modern laparoscopy. Despite these advances, the reliance on monopolar electrosurgery persists because of its wider range of tissue effects and dissection capabilities. At present, there is no clear evidence to support the use of either advanced bipolar or ultrasonic devices in preference to the other, although each technology has well-characterized advantages and disadvantages. It is likely that the surgeon will rely on 2

References (23)

  • G. Katsuno et al.

    Comparison of two different energy-based vascular sealing systems for the hemostasis of various types of arteries: a porcine model-evaluation of LigaSure ForceTriadTM

    J Laparoendosc Adv Surg Tech Part A

    (2010)
  • Cited by (58)

    • A comparison of short-term outcomes of neck dissection for head and neck cancers using Thunderbeat™, LigaSure™ or treatment without an energy-based device: A case controlled study

      2018, International Journal of Surgery
      Citation Excerpt :

      Several studies have demonstrated that operative time and intraoperative blood loss are related to clinical outcomes and complications in head and neck surgery [6–8]. Over the last two decades, various energy-based devices (EBDs) have been developed to achieve surgical hemostasis [9,10]. EBDs enable operative time to be reduced through sutureless vessel ligation without increasing postoperative complications [11,12].

    • Understanding and Practising Safe Electrosurgery in the Operating Room

      2018, Journal of Obstetrics and Gynaecology Canada
    • Risk management for surgical energy-driven devices used in the operating room

      2018, Journal of Visceral Surgery
      Citation Excerpt :

      Poor visualization of the tip of instruments during their trajectory and thermal diffusion are possible explanations for the origin of these complications. To avoid them during use of monopolar or bipolar electrocoagulation, it is recommended to use the lowest intensity of current possible, and to concentrate the electrocoagulation on a small surface while limiting the time of electrocoagulation and avoiding carbonization as much as possible [3,8,9]. Other recommendations such as avoiding any contact between activated monopolar instruments and other devices and privileging the use of trocars that are entirely metallic or plastic are solutions to avoid the risk of visceral burns.

    View all citing articles on Scopus

    The authors declare that they have no conflict of interest.

    View full text